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#HRB30 Story

Solving the mystery of unexplained chest pains

21 December 2016

Sometimes patients have chest pains that seem to come from blocked arteries around the heart, but the tests show everything is fine because it is the smaller arteries around the heart that are often causing the trouble. This can lead to patient frustration, expensive and invasive but unnecessary tests and no proper diagnosis or treatment. Thanks to HRB-funded research at University College Cork we now know that around 1% of patients going for angiogram could be Cardiac Syndrome X patients and that Syndrome X pain is linked with specific biochemical signs of inflammation in the body. This helps to dispel the notion that the pain is imagined rather than real, and it could lead to more definitive diagnosis. Because of the findings, a new clinic for Cardiac Syndrome X patients has been set up in Cork.

University College Cork, lead researcher Dr James Dollard

The problem

For a long time, cardiologists have scratched their heads about patients who show up with chest pains when they exercise (angina) but when you put them on a treadmill for a ’stress test’ or look inside their arteries for blockages, everything seems normal. Patients with this Cardiac Syndrome X often don’t get treated for their pain (which can drag on for years) and they can be at higher risk of psychological problems such as depression and anxiety. Some doctors consider Cardiac Syndrome X to be psychosomatic (arising in the mind of the patient), but science has shown it may be because smaller blood vessels around the heart are not working properly.

The project

Dr James Dollard identified 17 patients who had Cardiac Syndrome X and followed them for 18 months. He collected information about whether the pains endured or got better, and he analysed blood samples from the patients for markers of inflammation, a process that can damage arteries.

The outcomes
  • The study found that 1.3% of patients going for coronary angiograms in the study had Cardiac X Syndrome, this is the first report of its frequency in Ireland.
  • We now know that patients with Cardiac X Syndrome who have chest pains also have specific biochemical signs of inflammation in their body, offering doctors potential ways to help diagnose and monitor the condition. 
  • ‘MicroRNAs’ involved in blood vessel function, muscle development and possibly mood are altered in patients with Cardiac X Syndrome who have pain, suggesting biochemical mechanisms that underpin the condition.
  • The study should help doctors to better identify patients with Cardiac X Syndrome and ensure they get reassurance and that they avoid expensive and invasive but unnecessary tests.
  • A dedicated clinic has been established in Cork for patients with suspected Cardiac X Syndrome.

Dr James Dollard says:

'Every specialty has its ‘black sheep’ and in cardiology, a lot of people considered this Cardiac Syndrome X as being in the mind rather than a cardiovascular problem. This research has not only measured how frequently these patients are likely to turn up in the clinic with pain, but it has also measured the biochemical signals that tell us what is going on in the person’s body. Having a label for the pain helps the individual patient - they are reassured and hopefully it means they can get the treatment they need'.



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